Meta-analysis comparing direct oral anticoagulants to vitamin K antagonists for the management of left ventricular thrombus

Hesham K. Abdelaziz, Michael Megaly, Maciej Debski, Amr Abdelrahman, Shehab Abdelaziz, Diaa Kamal, Billal Patel, Ranjit More, Tawfiq Choudhury

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: To compare vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) treatment in patients with left ventricular (LV) thrombus. The primary outcome was stroke or systemic embolism (SSE). Secondary outcomes were thrombus resolution, bleeding, and death. 

Areas covered: Five observational studies were included (total n = 700; VKAs n = 480; DOACs n = 220). There was a trend toward less SSE with VKAs compared to DOACs (5.2% vs. 9%; odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.29–1.01, p = 0.05). No significant difference between VKAs and DOACs in rates of thrombus resolution (61.6% vs. 56.8%; OR = 1.00, 95% CI = 0.58–1.73, p = 0.99), bleeding (8.2% vs. 4.4%; OR = 1.62, 95% CI = 0.69–3.77, p = 0.27), or death (12.7% vs. 11.8%; OR = 1.09, 95% CI = 0.59–2.0, p = 0.79) was noted. In non-primary percutaneous coronary intervention setting, VKAs were associated with less SSE in prespecified analysis (5.2% vs.10.6%; OR = 0.48, 95% CI = 0.25–0.93, p = 0.03). 

Expert opinion: The current meta-analysis suggests a trend toward higher SSE with the use of DOACs compared to VKAs. Our recommendation is for VKAs to retain the preferred management of LV thrombus with cautious off-label use of DOACs.

Original languageEnglish
Pages (from-to)427-432
Number of pages6
JournalExpert Review of Cardiovascular Therapy
Volume19
Issue number5
Early online date8 Apr 2021
DOIs
Publication statusPublished - 13 Apr 2021

Keywords

  • Left ventricular thrombus
  • direct oral anticoagulants
  • stroke
  • systemic embolism
  • vitamin K antagonist

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